Cornell University Medical College - Samaritan Yearbook (New York, NY)

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all provide better than adequate care for the sick. It must carry out far-reaching research plans in medicine to en- rich our cultural base and eventually make even better medi- call care possible. And it must teach-must train its students to carry on -both the other parts of its program with com- petence and assurance. Let us now examine how that is 'being done at the present time at the Cornell-New York Hospital Medical Center. When the medical school first moved uptown to its present quarters and assumed its impressive hybrid title, a most important change was made in the nature of the faculty that requires some discussion. At that time the men responsi'b'le for the shaping of the new unit felt that the job of running its various subdlivisions required the undivided attention of the men in charge. Accordingly, the professorships of the major clinical departments were made for the first time full time positions. It was required that the men who filled these positions should hold no others and should have no private practice outside the hospital. Many of the men who already had large and lucrative practices naturally felt unwilling to give them up so that the personnel shifted sharply with the move. This was the logical culmination. of the trend to hospital medicine-to the picture of the physician as a specialist. The new men were themselves products of the new training and their efforts were oriented to it. With the rapid ad- vances in laboratory techniques and the overwhelmingly massive addition of source information to each facet of medicine the institution of full time clinical professors foredestined the Cornell student to be slanted for spe- cialization. Surprisingly the curriculum and the methods of teaching have had to be changed very little to point the way to the new medicine. The student spends the first two years of his course in the classrooms and laboratories of the five buildings fronting on York Avenue. He takes anatomy and biochemistry, physiology and bacteriology, pathology and pharmacology. He is then briefly introduced to physical di- agnosis. The third year he spends on the wards of the various clinical specialties. The fourth year he spends mainly in the out-patient departments. The variable factor is not, obviously, the subjects taught, but the orientation of the men who do the teaching. The increasing segmentation of labor at all levels is the phenomenon of our age. The expanding complexities of Kipx Bay-Yorkville Health Center. Stadentf get first Ivana' experience u in pnblir health work. civilization have brought us to a point where no one can hope to follow it all-few can hope to fo-llow more than one or two threads. This is especially true in medicine where the geometrically multiplying data are inexorably eradicating the general practitioner. In his place is spring- ing up a veritable horde of specialists. The specialties are formed and then sub-divided. As the divisions overlap one with the other, they split again. The orderly procession of it all must delight the Aristotelian lover of the syllogism, but it cannot help but confound us who hope to find somewhere in the maze a niche of our own. Faced with this situation the school can do nothing else but try to fit us for the specialist future, and this it is doing. In so doing it is forced to choose carefully the weightqof each course, each fragment of course, in the curriculum. For that reason it must weed out not just that which is completely valueless but also that which is of relatively little use in train- ing us for the future that has been chosen for us. The preclinical courses are taught, with minor excep- tions, with an eye to the clinical problems and procedures that arise from them. Especially in the dynamic sciences of physiology and biochemistry we are early madeto see the . . . laboratory advice and arrirtancef' D80 --,tt Q-L 'al W Q. clinia learn the 1 is thi beconi based into often, most Rathe basic Mu widely the pf ology there bemoa search of thi eries 2 llle W4 made trainin ITIOIE 1 Thei Certain Q and rn Which trainini flecessa all, me is a lil of lengths bfi add, ratio al This HFC of infc his foul Out th, Orin the if dang

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But all this is but the setting of medical education. It had a two-fo'ld effect on the students. It produced, first of all, the first generation of physicians trained for institutional practice rather than in- dividual private practice. It produced secondly a grou a , P dedicated to the furtherance of medicine through the pursuit type of training given the of the basic sciences and their implications in clinical practice. In.itially these trends were complementary-both groups of men needed to cluster around the large teachin ' 8 institutions of medicine where facilities for intensive study -clinical and laboratory-were available. In many cases the groups overlapped, with men working along both ap- proaches. The need for medical centers lavish with equip- ment and material arose g the need was inevitably fulfilled. With the knowledge churned up in increasing quantity by workers along both avenues of investigation their essen- tial dichotomy has become more and more marked. No longer is it possible for one worker to straddle the clinical and purely laboratory fields. And the necessity of determ- ining the amount of stress to be laid on each approach in the medical curriculum is responsible for the split in present day education wh.ich will be discussed later. The original faculty of the medical school was a dis- tinguished one and as new departments were organized, or old ones re-organized many more outstanding men were added to lit. Because of the important contributions to medi- cine made by these men, as well as the progressive policies of the school, Cornell rapidly became one of the most im- portant medical schools in the country. Its rapid growth soon made clear the inevitable insufficiency even of the excellent building opposite Bellevue. This, plus the neces- sity of tying up with some voluntary hospitall, led to the permanent afiiliation with New York Hospital and the dcision to consolidate the two institutions in one architec- tural unit. This had more than a symbolic importance. It made it possible for the first time for the two phases of education, the pre-clinical and the clinical, to be integrated more completely. It recognized the need for such integ- ration on the higher level of faculty co-operation. It made it possible for both groups of workers to be associated in a common organization and to mee-t informally in each others work areas and formally in joint conferences whose subject matter was of interest to -both. The assurance that the students will carry over into their clinical work medical the essentials of the basic courses of the first two years is predicated on the mutual respect of the teachers in both groups. In the years that the school was located on First Avenue there was a more complete physical severance between the ' an there is in the new two sections of the curriculum th consolidated unit. This split was minimized by the very competent and brilliant instruction of the faculty members and their participation in 'both clinical and pre-clinical work. These men were mainly responsible for the shape of Cor- nellfs development in those years and also laid the attern P for the type of instruction that has continued to be given at the institution. If the pre-clinical teachers do not indicate the tieups the student must make between the courses of his first two years and those of his later career, and if the clinical pro- fessors do not strongly outline the fundamental basis of the clinical entities they are describing, the student will never be a successful practitioner of modern medicine. The con- nection is not often an easy one to trace and the task of making the student see the natural evolution of disease from the processes of physiology and chemistry -he has previously learned is one that takes inhnite pain in its carrying out. Much that has been written in recent years on the subject of medical education .has been aimed at pointing out this fact and suggesting new schemes for accomplishing the rapprochement more effectively. These will be discussed more fully further on. Another important result of the establishment of the medical center was the gathering together in one functional unit of leading workers in all the various medical special- ties. This made it possible for the most thorough and up- to-date methods of attack to be leveled at medical problems from all angles at once. The internist working on diabetes, for example, now had the advantage of expert ophthalmo- logic, endocrinologic, surgical, laboratory advice and assist- ance. He had also close at hand facilities for cllinical and fundamental research on the problem. He had frequent conferences with other men on the staff in which he could glean the most recent advances in their work and their recent clinical experiences. But with this he also acquired the obligation to synthe- size this wealth of experience and transmit it to the student in its clearest and most available fo-rm. The function of a medical center such as ours is threefold. It must first of . . . wzzrdr filled wills az wzriezy of carer for .ftzzdy.

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. . .rurprififzgly little change in cw'rirzzlzzm. D clinical implications of the fundamental pninciples we are learning. The effect is to focus our attention away from the fundamentals and on their implications, for after all, is this not what we have come to medical school for? We become not men of science, but physicians, with our feet based on the 'loam of science and our heads stretched up into the ether that is still clinical medicine. We are told, often, that the best physician is the one who knows the most basic science. But our training does not bear this out. Rather the best physician is the one who knows enough basic scientific theory to temper the art of medicine. Much has been written about this in the literature. It is widely claimed that too much time has been allotted to the preclinical subjects. Anatomy should be shortened. Physi- ology and chemistry should be combined. Perhaps. But there is an increasingly insistent cry that on the other hand bemoans the dwindling number of men delivered into re- s h b ' earc y the medical schools of the country. The holders of this view point out that most of our important discov- eries are being made by men who are not physiciansg that the work in -the areas in which medical progress must be made is being done by men who have had no medical training. Thisview demands more theory, more technique, more stimulus to do original investigative work. There canno Certainly men trained in 'both approaches are needed g that they cannot be trained in both at once has become more and more apparent. Each school must choose, must decide which type of training .it will stress and then give that tra. .A . . . ining without introducing more of the other than is necessary to give the student a solid foundation For after ll a , medical school is still only 'four years lon and th g, ere is a limit to how much one can assimilate in that period of time Already this time factor h b t be a right and a wrong to this problem. r. Mor1'ill. Q . . . anzpbilbefzten wizb fezciliti Delivery Room. er for demofzslmlizzg paziiefztff' groups meez in each ozlzerhf work azrenzff' Dr. Model! and Dr. Gold . . . Me five bzzildizzgf fronlifzg on York Avenue. A. ta , as een attacked by the lengthening house staff training. Much more time cannot y be added at any point without making the trainingf practice p M pi A ty, fafio atbSufd1Y lafge- This is the approach to the group problem. In it we are likely to lose sight of the individual problem. The mass S Mm ff ttsi of information that must be presented to the student in P p 1 .fs2 i f his four years is great and fairly well standardized throughf' fp yppfi out the country, with the emphasis varying according to 7 p the orientation to the problems outlined above. This makes .H i it dangerously easy for the teach-ing methods to rely heavily ,tvzv ' 09a --